Colorectal Surgery Update

COLORECTAL SURGERY UPDATE

“UCSF Bakar Cancer Hospital features a lot of integration of systems, which will enhance our treatments,” said Madhulika Varma, MD, chief of the section of colorectal surgery. Spacious operating rooms easily accommodate large equipment needed for robotic surgery and intraoperative radiation, and new communication systems allow surgeons to participate in telemedicine video consults during a case without leaving the operating room.

Varma and her colleagues are leading many initiatives to improve patient care, including:

n Enhanced Recovery After Surgery (ERAS), which improves surgical outcomes and patient experience. Under the direction of surgeon Ankit Sarin,

MD, MHA, and anesthesiologist Lee-

Lynn Chen, MD, a team of surgeons, anesthesiologists, pain management specialists, nurses and other health care professionals work collaboratively to implement effective, evidencedbased interventions to accelerate recovery. These include efforts to optimize patient health before surgery, tailoring medications and fluids during surgery and using nonopioid pain medications after surgery to support increased mobility and earlier return to eating solid food. In its first year, the program has reduced length of hospital stay and readmissions, decreased patients’ pain scores and shortened time to patients’ first postoperative solid meal.

“A main factor that keeps people in the hospital after colorectal surgery is not having their intestines work, and opioids can affect intestinal motility,” said Varma. “Also, by delivering pain care while using less narcotics, we help people get up and moving without nausea or dizziness. Patients tell me, ‘I didn’t think I would feel this good after having a big surgery,’ and all the interventions have a lot to do with that.”

Madhulika Varma, MD Ankit Sarin, MD, MHA Lee-Lynn Chen, MD

n Reducing infection and readmission rates: Colorectal surgery is often associated with a higher rate of infection due to bowel involvement. UCSF

Medical Center has implemented interventions to reduce infections.

n Improving patient education and perioperative care: UCSF Medical

Center is part of a UC-wide consortium to improve care for patients undergoing high-risk colorectal surgery, producing educational videos for ileostomy patients, with forthcoming videos about colon and rectal surgery.

UCSF Medical Center is also hiring a nurse practitioner to assist recently discharged patients with stoma and medication management, and connects prospective patients with former patients who can help them better prepare.

n Minimally invasive surgery: UCSF

Medical Center is a leader in laparoscopic surgery, including robotic surgery, enabling surgeons to manipulate instruments with greater degrees of freedom. This is particularly helpful in confined spaces such as the rectum.

Also, transanal endoscopic microsurgery (TEM) allows surgeons to insert laparoscopic tools through the anus to conduct complex rectal surgery, improving accuracy while eliminating abdominal incisions.

n Joint operations: Colorectal surgeons work closely with other surgical specialists to provide comprehensive care. For example, colorectal and liver surgeons often jointly perform surgery to remove intestinal cancer that has metastasized to the liver. Colorectal and urologic surgeons remove intestinal tumors adhering to the bladder or prostate, and repair rectourethral fistulas related to prostate cancer. Colorectal surgeons work with plastic surgeons to create muscle and skin flaps in cases where large colorectal tumors have been removed.

Dr. Varma examines a patient.

n Pioneering new treatments: The

UCSF Center for Pelvic Physiology evaluates patients with fecal incontinence, constipation and pelvic floor prolapse, and tests new therapies.

The center recently completed an investigational trial in tibial nerve stimulation, inserting electrodes into the foot for short periods to improve fecal incontinence.

“UCSF Bakar Cancer Hospital brings everyone together to create innovative programs,” said Varma. “There is a lot of energy and excitement about having this new campus in which to grow, and our dedicated doctors and staff are constantly pushing the envelope to help patients in novel ways.”

FOR MORE INFORMATION:

Visit colorectal.surgery.ucsf.edu and eras.surgery.ucsf.edu. To refer a patient, visit colorectal.surgery.ucsf.edu/referrals or call 415-885-3606.